(1) When an acupuncturist or acupuncture and Eastern medicine practitioner sees a patient with a potentially serious disorder, the acupuncturist or acupuncture and Eastern medicine practitioner shall immediately request a consultation or written diagnosis from a primary health care provider.

(2) Potentially serious disorders include, but are not limited to:

(a) Cardiac conditions including uncontrolled hypertension;

(b) Acute abdominal symptoms;

(c) Acute undiagnosed neurological changes;

(d) Unexplained weight loss or gain in excess of fifteen percent body weight within a three-month period;

(e) Suspected fracture or dislocation;

(f) Suspected systemic infection;

(g) Any serious undiagnosed hemorrhagic disorder; and

(h) Acute respiratory distress without previous history or diagnosis.

(3) In the event a patient with a potentially serious disorder refuses to authorize such consultation or provide a recent diagnosis from a primary health care provider, acupuncture or Eastern medicine treatments, may only continue after the patient signs a written waiver acknowledging the risks associated with the failure to pursue treatment from a primary health care provider.

(4) The written waiver must include:

(a) A statement acknowledging that failure by the patient to pursue treatment from a primary health care provider may involve risks that such a condition can worsen without further warning and even become life threatening;

(b) An explanation of an acupuncturist's or acupuncture and Eastern medicine practitioner's scope of practice, to include the services and techniques acupuncturists or acupuncture and Eastern medicine practitioners are authorized to provide; and

(c) A statement that the services and techniques that an acupuncturist or acupuncture and Eastern medicine practitioner is authorized to provide will not resolve the patient's underlying potentially serious disorder.